Christopher Kirk-Ryan Phillips, D.D.S
Individual provider Active NPI Dentist · Woodbury, TN
NPI 1205409554 · NPPES record last updated Apr 28, 2022
Key facts
- NPI
- 1205409554
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 11793 (TN)
- Practice address
- 801 W Main St Ste B
Woodbury, TN 37190-1048 - Phone
- (615) 563-2266
- NPI assigned
- Jul 22, 2021
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 106591 | CA | MD | Dentist |
| 11793 | TN | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Chokka Dental Corporation | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 106591 | CA | |
| Dentist | 122300000X | 11793 | TN | Yes |
Addresses
Primary practice location
801 W Main St Ste B
Woodbury, TN 37190-1048
Mailing address
1576 Birchwood Cir
Franklin, TN 37064-6871
Phone (909) 856-2011
Other practice location 1
34880 Yucaipa Blvd
Yucaipa, CA 92399-4235
Phone (909) 797-1136
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | CPS |
Other providers in Woodbury, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 28, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.